CPT 80359 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Therapeutic Drug Assays |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80359 |
| Medicaid Fee Schedule | View Medicaid rates for 80359 |
National average reimbursement for CPT 80359 by major payers:
$19.41
$14.33
$2.38
$50.02
CPT 80359 vs. Other Therapeutic Drug Assays Codes
The CPT 80359 code is part of the Pathology and Laboratory Procedures services used for Therapeutic Drug Assays. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 80359 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 80346-CPT | Low | Sedative Therapy Monitoring, Benzodiazepines Are A Class Of Sedatives That Can Have Strong Effects. A Blood Analysis Helps To Determine A Therapeutic Dose And Can Show Other Issues Such As Overdosing. |
| 80359-CPT | Low | Drug Screening, This Test Measures The Amount Of Methylenedioxyamphetamines Present In Blood And Urine Samples. |
| 80361-CPT | Low | Opiate Drug Screening, This Test Measures The Amount Of Opiates (Narcotic Painkillers Such As Morphine Or Codeine) Present In Blood And Urine Samples. |
| 80362-CPT | Low | Opiate Drug Screening, This Test Measures The Amount Of Opiates (Narcotic Painkillers Such As Morphine Or Codeine) Present In Blood And Urine Samples. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80359. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80359 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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